Disorders - Obsessive Compulsive Disorder
Franklin, Martin E., Sapyta,
Jeffrey, Freeman, Jennifer B., Khanna, Muniya, Compton, Scott, Almirall, Daniel, Moore, Phoebe, Choate-Summers, Molly, Garcia, Abbe, Edson, Aubrey L., Foa, Edna B., March, John S.
Context: The extant literature on the treatment of pediatric obsessive-compulsive disorder (OCD) indicates
that partial response to serotonin reuptake inhibitors (SRIs) is the norm and that augmentation with short-term OCD-specific cognitive behavior
therapy (CBT) may provide additional benefit. Objective: To examine the effects of augmenting SRIs with CBT or a brief form of CBT, instructions in
CBT delivered in the context of medication management. Design, Setting, and Participants: A 12-week randomized controlled trial conducted at 3
academic medical centers between 2004 and 2009, involving 124 pediatric outpatients between the ages of 7 and 17 years with OCD as a primary
diagnosis and a Children's Yale-Brown Obsessive Compulsive Scale score of 16 or higher despite an adequate SRI trial. Interventions: Participants
were randomly assigned to 1 of 3 treatment strategies that included 7 sessions over 12 weeks: 42 in the medication management only, 42 in the
medication management plus instructions in CBT, and 42 in the medication management plus CBT; the last included 14 concurrent CBT sessions. Main
Outcome Measures: Whether patients responded positively to treatment by improving their baseline obsessive-compulsive scale score by 30% or more and
demonstrating a change in their continuous scores over 12 weeks. Results: The medication management plus CBT strategy was superior to the other 2
strategies on all outcome measures. In the primary intention-to-treat analysis, 68.6% (95% CI, 53.9%-83.3%) in the plus CBT group were considered
responders, which was significantly better than the 34.0% (95% CI, 18.0%-50.0%) in the plus instructions in CBT group, and 30.0% (95% CI, 14.9%-
45.1%) in the medication management only group. The results were similar in pairwise comparisons with the plus CBT strategy being superior to the
other 2 strategies (P < .01 for both). The plus instructions in CBT strategy was not statistically superior to medication management only (P = .72).
The number needed-to-treat analysis with the plus CBT vs medication management only in order to see 1 additional patient at week 12, on average, was
estimated as 3; for the plus CBT vs the plus instructions in CBT strategy, the number needed to treat was also estimated as 3; for the plus
instructions in CBT vs medication management only the number needed to treat was estimated as 25. Conclusions: Among patients aged 7 to 17 years with
OCD and partial response to SRI use, the addition of CBT to medication management compared with medication management alone resulted in a
significantly greater response rate, whereas augmentation of medication management with the addition of instructions in CBT did not. (PsycINFO
Database Record (c) 2012 APA, all rights reserved) (journal abstract)
JAMA, 306(11) : 1224-1232
- Year: 2011
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Exposure therapy, Exposure
and response prevention
Davis-III,
TE., May, Anna., Whiting, Sara E.
Research on treatments for childhood anxiety disorders has increased greatly in
recent decades. As a result, it has become increasingly necessary to synthesize the findings of these treatment studies into reviews in order to draw
wider conclusions on the efficacy of treatments for childhood anxiety. Previous reviews of this literature have used varying criteria to determine
the evidence base. For the current review, stricter criteria consistent with the original Task Force (1995) guidelines were used to select and
evaluate studies. Studies were divided by anxiety disorder; however, many studies combine various anxiety disorders in their samples. As a result,
these were included in a combined anxiety disorder group. Using more traditional guidelines, studies were assigned a status of well-established,
probably efficacious, or experimental based on the available literature and the quality of the studies. While some treatments do meet the criteria
for well-established status, it is clear from this examination that gaps remain and replication is necessary to establish many of these treatments as
efficacious. In addition, there still appears to be a lack of research on the effects of treatment on the physiological and cognitive aspects of fear
and anxiety. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
Clinical Psychology Review, 31(4) : 592-
602
- Year: 2011
- Problem: Anxiety Disorders (any), Obsessive Compulsive Disorder, Post Traumatic Stress Disorder, Social phobia (social anxiety disorder), Specific
Phobia
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any)
Bolton,
Derek, Williams, Tim, Perrin, Sean, Atkinson, Linda, Gallop, Catherine, Waite, Polly, Salkovskis, Paul
Background: Reviews and practice guidelines for paediatric obsessive-
compulsive disorder (OCD) recommend cognitive-behaviour therapy (CBT) as the psychological treatment of choice, but note that it has not been
sufficiently evaluated for children and adolescents and that more randomized controlled trials are needed. The aim of this trial was to evaluate
effectiveness and optimal delivery of CBT, emphasizing cognitive interventions. Methods: A total of 96 children and adolescents with OCD were
randomly allocated to the three conditions each of approximately 12 weeks duration: full CBT (average therapist contact: 12 sessions) and brief CBT
(average contact: 5 sessions, with use of therapist-guided workbooks), and wait-list/delayed treatment. The primary outcome measure was the child
version of the semi-structured interviewer-based Yale-Brown Obsessive Compulsive Scale. Clinical Trial registration: http://www.controlled-
trials.com/ISRCTN/; unique identifier: ISRCTN29092580. Results: There was statistically significant symptomatic improvement in both treatment groups
compared with the wait-list group, with no significant differences in outcomes between the two treatment groups. Controlled treatment effect sizes in
intention-to-treat analyses were 2.2 for full CBT and 1.6 for brief CBT. Improvements were maintained at follow-up an average of 14 weeks later.
Conclusions: The findings demonstrate the benefits of CBT emphasizing cognitive interventions for children and adolescents with OCD and suggest that
relatively lower therapist intensity delivery with use of therapist-guided workbooks is an efficient mode of delivery. (PsycINFO Database Record (c)
2012 APA, all rights reserved) (journal abstract)
Journal of Child Psychology & Psychiatry, 52(12) : 1269-1278
- Year: 2011
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other service delivery and improvement
interventions
Gentile, Salvatore
The aim of this article was to analyze
systematically literature information published in English (between 1966 and January 2011) on the efficacy of antidepressants in pediatric
obsessive-compulsive disorder. Data were identified through different databases by using variously combined patterns of search terms. Searches
provided 85 articles, excluding duplicates, but only articles reporting primary data on use of antidepressants in this specific disorder were
reviewed. Fifty-nine articles were excluded because they did not report primary efficacy data or investigated patients with different psychiatric
diagnosis. Twenty-five electronically recognized articles met the inclusion criteria. Two additional studies, available as congress communication,
were identified by manually checking the references' list of electronically identified articles. Reviewed studies show several methodological biases
(the lack/limited number of long-term trials and head-to-head comparisons and the inclusion of patients who continued different forms of
psychotherapy), which make it difficult to individuate the best pharmacological strategy. Despite these limitations, evidence-based information
suggests that clomipramine and sertraline, especially for long-term treatments, should be considered as first-choice agents for treating obsessive-
compulsive disorder at onset during childhood or adolescence.
Journal of Clinical Psychopharmacology, 31(5) : 625-632
- Year: 2011
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Tricyclic antidepressants
Gomes, J. B., Matte, B. C., Vivan, A., Viana, A., Bortoncello, C. F., Salum, G. A., Aline Hartmann Zottis, G.
Obsessive-compulsive disorder (OCD) is a severe mental disorder with serious consequences to family dynamics. Therefore, parental involvement
seems to be a key factor for the successful treatment of this psychiatric disorder. The aim of this study was to evaluate the level of evidence
available to allow recommendation of cognitive behavioral therapy (CBT) with family intervention for the treatment of children and adolescents with
OCD. The systematic search was performed on MEDLINE/PubMed, followed by analysis of abstracts and full-length articles by two independent evaluators.
Subsequently, an analysis of the evidence available was conducted using the Grading of Recommendations Assessment, Development and Evaluation (GRADE)
system. The effect size of the intervention was calculated using Cohen's d. We found 77 articles on PubMed, plus 12 articles via cross-reference
search. Of these, seven articles were included in this review, according to the following criteria: intervention study, involving only children
and/or adolescents, and a having a structured or clinical diagnosis of OCD. The Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) was used
for outcome evaluation in all articles, thus enabling assessment of the effect size of non-controlled interventions (d = 1.43), resulting in a mean
difference of 13.11 points (95%CI 11.84-14.39; p < 0.001). Conversely, a high heterogeneity was detected among the studies (I2= 67%). Family-based
CBT seems to have an important effect on the reduction of OCD symptoms in children and adolescents. However, the small number of studies available do
not allow us to establish an evidence level higher than C for this recommendation. New randomized clinical trials are needed to confirm this
recommendation. (copyright) Revista de Psiquiatria do Rio Grande do Sul - APRS.
Revista de Psiquiatria do Rio Grande do Sul, 33(2) : 121-127
- Year: 2011
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Joseph, L., Grant, P., Swedo, S.
Background:
Obsessive-Compulsive Disorder (OCD) affects 1 - 2% of children and adolescents, causing significant distress and impairments of functioning. Anti-
obsessional medications (typically SSRIs) and cognitive-behavioral therapy are beneficial to many, but not all children. Preliminary data from
studies of adults suggest that riluzole, a drug that affects glutamate within the CNS, may be effective for patients who have failed to respond to
other medications. The purpose of this study was to conduct a randomized, placebo-controlled trial of riluzole in children and adolescents with OCD
to determine if riluzole would reduce symptoms to a greater extent than placebo. Methods: Participants were 60 children and adolescents (44 males, 16
females; mean age 14.4 (plus or minus) 2.3 yrs) with moderate to severe OCD (CYBOCS mean total score=28.17(plus or minus)3.7). All had failed to
respond adequately to standard therapies (on average, children were taking 2 psychotropic medications at baseline). 17 of the 60 subjects had an
autism spectrum disorder in addition to OCD. Subjects were randomly assigned to receive capsules containing placebo (PLA) or riluzole (RIL; 50 mg q
12 hrs) for 12 weeks. Symptom ratings were completed at biweekly intervals; the final blinded ratings (at 12 weeks) of obsessive-compulsive symptoms,
anxiety and depression were used for analyses. Those completing the 12 weeks doubleblind trial were offered open-label RIL and all elected to take
RIL for the next nine months (total study duration=1 year). Results: 51 children completed the double-blind phase of the study. The drug was
generally well-tolerated, but there was one serious adverse event (a child taking multiple drugs developed pancreatitis; he recovered fully after
RILand other drugs were D/C0ed) 5 children had modest transaminase elevations during RIL administration. An intent-to-treat analysis (using last data
point recorded) found no significant differences in ratings of OCD, depression or anxiety between the 30 children randomized to PLA and the 30 in the
RIL group. Analysis of data from those completing 12 weeks of study drug (RIL n=22; PLA n=29) revealed significantly greater improvements in OCD
symptoms during RIL administration (CY-BOCS total score from baseline to 12 weeks: RIL 27.3 (plus or minus) 3.7 to 20.6 (plus or minus) 6.4; PLA 29.0
(plus or minus) 3.5 to 23.3 (plus or minus) 4.7). RIL was also superior to PLA on ratings of compulsions (CY-BOCS Compulsions: RIL 13.8 (plus or
minus) 1.9 to 10.4 (plus or minus) 3.7; PLA 14.6 (plus or minus) 1.9 to 11.9 (plus or minus) 2.5). Patients continued to improve throughout the 9
months of open-label RIL administration, with all subjects reporting less OCD, anxiety and depression at 1 yr than at baseline. Discussion: This
small study of the efficacy and safety of riluzole for children and adolescents with OCD demonstrated some benefits, particularly following open-
label administration for 9 months. However, the differences between riluzole and placebo were statistically significant only when examined for the
cohort of children who completed the 12 weeks double-blind trial. The lack of significant differences on the intent-to-treat analysis appears to be
due, at least in part, to the larger number of children withdrawn from the active study group due to adverse effects, including one episode of
pancreatitis. Despite these limitations, the results of this trial are encouraging and warrant replication and extension to a cohort of children
without a history of multiple treatment failures. It would also be interesting to test the efficacy of RIL as a solitary treatment, rather than as an
nullaugmenting agentnull added to a current, non-effective treatment regimen (as was done in this study).
Neuropsychopharmacology, 36 : S228-S229
- Year: 2011
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Treatment resistant/treatment refractory
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions
Schlup, Barbara, Farrell, Lara, Barrett, Paula
This waitlist-controlled study investigates the impact of a group-based cognitive-behavioral therapy with family involvement
(CBT-F) on observed mother and child behaviors in children with obsessive-compulsive disorder (OCD). Forty-four children and adolescents with OCD and
their mothers were observed during family discussions before and after treatment/waitlist. Participants were rated on behavioral dimensions of
criticism, overinvolvement, doubt, avoidance, warmth, confidence, positive problem solving, and rewarding independence. Significant differences
between treatment and waitlist condition occurred from pretreatment to posttreatment, with ratings of negative behaviors decreasing and ratings of
positive behaviors increasing in the treatment group. Findings suggest that CBT-F has the potential to improve mother and child interactions in
families with a child diagnosed with OCD. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
Child & Family Behavior Therapy, 33(4) : 322-
336
- Year: 2011
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Schuck, Kathrin, Keijsers, Ger P.
J., Rinck, Mike
Thirty-four college students suffering from pathological skin picking were randomly assigned to a four-session cognitive-behavioural
treatment (n = 17) or a waiting-list condition (n= 17). Severity of skin picking, psycho-social impact of skin picking, strength of skin-picking-
related dysfunctional cognitions, and severity of skin injury were measured at pre-, post-, and two-months follow-up assessment. Participants in the
treatment condition showed a significantly larger reduction on all measured variables in comparison to the waiting-list condition. The obtained
effect sizes for the outcome measures were large, ranging from .90 to 1.89. Treatment effects were maintained at follow-up. In conclusion, cognitive
behavioural therapy, even in brief form, constitutes an adequate treatment option for pathological skin-picking behaviour. (PsycINFO Database Record
(c) 2012 APA, all rights reserved) (journal abstract)
Behaviour Research &
Therapy, 49(1) : 11-17
- Year: 2011
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Storch, Eric A., Caporino, Nicole E., Morgan, Jessica R., Lewin, Adam B., Rojas, Ariz, Brauer, Lindsay, Larson, Michael J., Murphy, Tanya K.
This
study reports a waitlist controlled randomized trial of family-based cognitive-behavioral therapy delivered via web-camera (W-CBT) in children and
adolescents with obsessive-compulsive disorder (OCD). Thirty-one primarily Caucasian youth with OCD (range=7–16years; 19 male) were randomly
assigned to W-CBT or a Waitlist control. Assessments were conducted immediately before and after treatment, and at 3-month follow-up (for W-CBT arm
only). Primary outcomes included the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS), clinical global improvement rates, and remission
status. When controlling for baseline group differences, W-CBT was superior to the Waitlist control on all primary outcome measures with large effect
sizes (Cohen's d ‚â•1.36). Thirteen of 16 youth (81%) in the W-CBT arm were treatment responders, versus only 2/15 (13%) youth in the Waitlist arm.
Similarly, 9/16 (56%) individuals in the W-CBT group met remission criteria, versus 2/15 (13%) individuals in the Waitlist control. Gains were
generally maintained in a naturalistic 3-month follow-up for those randomized to W-CBT. This preliminary study suggests that W-CBT may be helpful in
reducing obsessive-compulsive symptoms in youth with OCD. Given considerable access issues, such findings hold considerable promise for treatment
dissemination. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
Psychiatry Research, 189(3) : 407-
412
- Year: 2011
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Piacentini, John, Bergman, R. Lindsey, Chang,
Susanna, Langley, Audra, Peris, Tara, Wood, Jeffrey J., McCracken, James
Objective: To examine the efficacy of exposure-based cognitive-
behavioral therapy (CBT) plus a structured family intervention (FCBT) versus psychoeducation plus relaxation training (PRT) for reducing symptom
severity, functional impairment, and family accommodation in youths with obsessive-compulsive disorder (OCD). Method: A total of 71 youngsters 8 to
17 years of age (mean 12.2 years; range, 8–17 years, 37% male, 78% Caucasian) with primary OCD were randomized (70:30) to 12 sessions over 14 weeks
of FCBT or PRT. Blind raters assessed outcomes with responders followed for 6 months to assess treatment durability. Results: FCBT led to
significantly higher response rates than PRT in ITT (57.1% vs 27.3%) and completer analyses (68.3% vs. 35.3%). Using HLM, FCBT was associated with
significantly greater change in OCD severity and child-reported functional impairment than PRT and marginally greater change in parent-reported
accommodation of symptoms. These findings were confirmed in some, but not all, secondary analyses. Clinical remission rates were 42.5% for FCBT
versus 17.6% for PRT. Reduction in family accommodation temporally preceded improvement in OCD for both groups and child functional status for FCBT
only. Treatment gains were maintained at 6 months. Conclusions: FCBT is effective for reducing OCD severity and impairment. Importantly, treatment
also reduced parent-reported involvement in symptoms with reduced accommodation preceding reduced symptom severity and functional impairment.
(PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
Journal of the American Academy of Child & Adolescent Psychiatry, 50(11) : 1149-
1161
- Year: 2011
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Family therapy, Psychoeducation, Relaxation
Storch, E. A., Murphy, T. K., Goodman, W. K., Geffken, G. R., Lewin, A. B., Henin, A., Micco, J. A., Sprich, S., Wilhelm, S., Bengtson, M., Geller, D. A.
Background Research on the neural circuitry underlying fear
extinction has led to the examination of D-cycloserine (DCS), a partial agonist at the N-methyl-D-aspartate receptor in the amygdala, as a method to
enhance exposure therapy outcome. Preliminary results have supported the use of DCS to augment exposure therapy in adult anxiety disorders; however,
no data have been reported in any childhood anxiety disorder. Thus, we sought to preliminarily examine whether weight-adjusted DCS doses (25 or 50
mg) enhanced the overall efficacy of cognitive-behavioral therapy (CBT) for pediatric obsessive-compulsive disorder (OCD). Method Participants were
30 youth (aged 817) with a primary diagnosis of OCD. The study design was a randomized, double-blinded, placebo-controlled augmentation trial
examining CBT + DCS versus CBT + Placebo (15 youth per group). All patients received seven exposure and response prevention sessions paired with DCS
or placebo taken 1 hour before sessions. Results Although not significantly different, compared with the CBT + Placebo group, youth in the CBT + DCS
arm showed small-to-moderate treatment effects (d = .31.47 on primary outcomes). No adverse events were recorded. Conclusions These results
complement findings in adult OCD and non-OCD anxiety disorders and provide initial support for a more extensive study of DCS augmentation of CBT
among youth with OCD. (copyright) 2010 Society of Biological Psychiatry.
Biological
Psychiatry, 68(11) : 1073-1076
- Year: 2010
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), D-cycloserine (DCS)
Williams, T. I., Salkovskis, P.
M., Forrester, L., Turner, S., White, H., Allsopp, M. A.
Cognitive behaviour therapy (CBT) for young people with
obsessive compulsive disorder (OCD) has become the treatment of first choice. However, the literature is largely based on studies emphasising
exposure and response prevention. In this study, we report on a randomised controlled trial of CBT for young people carried out in typical outpatient
clinic conditions which focused on cognitions. A randomised controlled trial compares 10 sessions of manualised cognitive behavioural treatment with
a 12-week waiting list for adolescents and children with OCD. Assessors were blind to treatment allocation. 21 consecutive patients with OCD aged
between 9 and 18 years were recruited. The group who received treatment improved more than a comparison group who waited for 3 months. The second
group was treated subsequently using the same protocol and made similar gains. In conclusion, CBT can be delivered effectively to young people with
OCD in typical outpatient settings. (copyright) 2009 Springer-Verlag.
European Child & Adolescent Psychiatry, 19(5) : 449-456
- Year: 2010
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)